“Our health needs a healthy environment”: Community Identified Climate Change and Health Priorities among the Batwa of Uganda

A report supporting the development of the IHACC research program.by Kathryn Dingle.


IHACC proposes a multi-year study assessing the vulnerability and adaptive capacity of the health systems of Uganda’s Batwa Pygmies to climate change as part of the IDRC’s International Research Initiative on Adaptation to Climate Change. The Batwa are indigenous to the equatorial rainforests of Central Africa, a region already experiencing changing temperature and precipitation patterns and predicted to face a heavy climate change burden in the future. The Batwa are former forest-dwelling hunter-gatherers who were evicted from their ancestral lands two decades ago. Today, many Batwa have taken up agriculture as a principal livelihood while others remain dependent upon work as hired labour or sales of crafts and tourist services. While increased accessibility of Western healthcare to the Batwa over the past decade has led to dramatic improvements in their wellbeing, their overall health status remains poor. This summer, the IHACC team worked with two Batwa communities in the highlands of southwest Uganda to conduct pilot research into this project using PhotoVoice and Rapid Rural Appraisal methods.

Description of Pilot Research

Pilot research took place in Uganda between June and August 2010. The objective of the research was to identify climate-sensitive health priorities of the Batwa Pygmies in Uganda’s Kanungu district. Meetings were first held in Kampala, Uganda’s capital, with local research organizations, NGOs, and government officials already working with the Batwa to introduce our project and discuss key research needs. In late June, the team first travelled to Kanungu district to meet with a number of Batwa communities and select two who would be interested in participating with us in more extensive pilot research during the month of July. The Batwa can currently be found in scattered settlements in three districts in southern Uganda – Kanungu, Kisoro, and Mbarara – surrounding Bwindi Impenetrable National Park. Kanungu district was chosen for its established research contacts as well as logistical concerns.

Study communities

The Batwa communities of Mukongoro and Kihembe were chosen for our pilot research. Both are found in the western part of Kanungu district, just north of Bwindi Impenetrable N.P. and east of the D.R.C. border. Mukongoro is located approximately 3km away from the nearest trading centre, Buhoma, and can be accessed only on foot. Buhoma, in turn, can be accessed by dirt road from Rukungiri town (82km, 3-4 hours) and tarred road from there to Kampala (390km, 6-8 hours). Kihembe is located approximately 30km away from Buhoma, an hour’s drive.

The communities were established in the early 2000s when local NGOs purchased land in these communities for the Batwa to build houses on and farm. Mukongoro consists of about 150 households, 12 of which are Batwa, while Kihembe is home to 15 households, all of which are Batwa.


After the initial entire HACC Uganda team’s trip out Kanungu in June, two student researchers returned to Buhoma in July to engage in further research with the community members of Mukongoro and Kihembe. When first arriving, we held a community-wide meeting to introduce ourselves formally to the community and set up a research schedule according to their wishes. We returned to the communities over the course of a three-week period to conduct the research. A variety of methodologies were used, with a strong focus upon participatory approaches and “bottom-up” learning from the community members themselves. While it was not possible to live with the communities for cultural and logistical reasons, as researchers we attempted to spend as much time as possible physically in the community to observe daily life as an informal supplement to our more structured research methods. We wrapped up our research in every community with a concluding community-wide meeting to review our findings and discuss future research needs. In addition to the work with the communities around Buhoma, we met with other Batwa NGO’s, health facilities, and researchers in the field and conducted semi-structured interviews with them focused upon current Batwa health status and sensitivities. Relevant research sites were georeferenced with handheld GPS over the course of the summer.


PhotoVoice seminars were conducted daily in each community. We would solicit interested participants and direct them in using the digital camera to answer the question of “How does the environment affect your health?” Each participant would have a few hours with the camera before returning to either a group or individual discussion (based upon appropriate circumstances) to review the photographs they had taken and explain the significance behind them. PhotoVoice was conducted with a total of 21 participants, split 10 men and 11 women.

Rapid Rural Appraisal

A number of RRA methods were used during the pilot research, including:

  1. Semi-structured household interviews: 21 interviews were conducted with 34 people, split about evenly between males and females depending upon what family members showed up in each household on the day of our scheduled interview with them. An interview guide was used (see Appendix 1). Interviews lasted between 30 minutes and 1 hour, with the average being around 40 minutes.
  2. Key informant interviews: One was conducted with the village chairman of each community to gather general information about their respective communities. See Appendix 2 for the interview guide used.
  3. Biographies: To illustrate the richness of Batwa life stories, detailed biographical interviews (see Appendix 3) were conducted with two randomly selected members of each community.
  4. Future storylines: During community-wide meetings as well as PhotoVoice group discussions, three future storylines to do with food, water, and malaria concerns were prompted to those present, soliciting answers which relate to the adaptive capacity of Batwa health systems. The future storylines were based upon climate change projections as identified by local climate leaders during field interviews.
  5. Participatory Mapping: In Kihembe, two adult males volunteered to map out their community for us on poster paper while in Mukongoro, one adult male and approximately 10 schoolchildren did the same.


Key health concerns as identified by the communities during the pilot research are as follows:


"Our biggest challenge to health is bad water…We understand that the water has infection.”

“We have no clean water. We use the stagnant water which kids play and bathe in. Every dry season it dries up and we must go somewhere else to fetch water…When that dries up, we go even further."


"When we don’t get all of our harvest, having enough food is a problem.”

“We get crop failure when the seasons change and we don’t expect it."


"We continuously dig on the same land, so it gets exhausted…We have small portions of land and the crops don’t grow very well.”

“When this soil becomes exhausted, we have no other land to move to."


"The mosquitoes will chew you…If you don’t have a mosquito net, you’ll suffer.”

“When kids sleep outside nets, they get mosquitoes and then they get malaria.”


"Our toilets are not good because they have no shelter. They can make us sick with things like diarrhoea.”


"In grass houses we have nowhere to put a mosquito net up.”

“Old women who sleep without something to cover them at night get coldness and fevers.”